Silicosis and the limitations of the Global Burden of Disease Study: a critical reflection on modelling estimates in low- and middle-income countries

Extractive operations are expanding in low- and middle-income countries (LMICs), resulting in a growing burden of silicosis. Given the need to promote knowledge and awareness of this disease, we are concerned by uncritical use of data reported by the Global Burden of Disease (GBD) project. We find that the outputs of the GBD for silicosis in LMICs conflict with recent available empirical data, including our research experience in mining cohorts, suggesting substantial underestimation in these countries. We attribute this, inter alia, to generic utilization of country vital statistics and misalignment of the models with industrial and occupational predictors of silicosis. Scarcity of data for model inputs and empirical silicosis estimates remains a serious barrier to accurate modelling. However, over-reliance on complex modelling tools can produce unintended consequences for public health policy and discourse. Collaborative global and country surveillance of silicosis is needed, aided by the expansion of newly available low-cost screening technology.